Give details of any physical disabilities which could affect this application:
Give details of why you may NOT be physically capable of carrying out the duties of the job for which you are applying (ie. phobia of heights):
Give details of any cautions or convictions for criminal offenses, which are not SPENT under the Rehabilitation of Offenders Act: 1974, including pending actions:
Give details of any bankruptcy proceedings and outstanding court judgements for debt:
Give details of any/all occasions when you have been dismissed by an employer:
Qualifications
Give details of all qualifications applicable to this application, including grade obtained:
Establishment
Course Title
Examination Date
Grade Obtained
References
Please give two references from persons of standing, who have known you for at least TWO years within the most recent FIVE years and to whom reference may be made. Referees should NOT be relatives, or persons residing at the same address as the applicant.
First Reference
Name:
Time Known:
Telephone:
Mobile:
Email:
Nationaility:
Relationship:
Address 1:
Address 2:
City/Town:
Postal Code:
County:
Country:
Second Reference
Name:
Time Known:
Telephone:
Mobile:
Email:
Nationaility:
Relationship:
Address 1:
Address 2:
City/Town:
Postal Code:
County:
Country:
Education & Employment History
Please give details, however brief, of ALL periods of EDUCATION, EMPLOYMENT, UN-EMPLOYMENT, SELF-EMPLOYMENT, WORKING ABROAD, EXTENDED PERIODS OD ILLNESS and time spent in HM FORCES, covering the last FIVE YEARS of your history, or back to the age of 21 if less than five years. If UN-EMPLOYED (this includes Housewife/House-Maker), show the area in which you were un-employed and the employment benefit office, if you were registered. If SELF-EMPLOYED, state the name of the business, the registered address and the name and address of ANY/ALL ACCOUNTANTS used. Start with the EARLIEST occurence, i.e. school or first job etc, and ensure that you give MONTH & YEAR in the sections FROM and TO.
